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. 2025 Aug;43(8):467.e13-467.e20.
doi: 10.1016/j.urolonc.2025.02.008. Epub 2025 Feb 28.

Association of metabolic syndrome and chronic kidney disease with nonmuscle invasive bladder cancer recurrence and progression

Christabel Egemba  1 , Sneha Kapil  1 , Tarek Ajami  2 , Adam Williams  2 , Bruno Nahar  2 , Sanoj Punnen  2 , Dipen J Parekh  2 , Mark Gonzalgo  2 , Chad R Ritch  3
Affiliations

Association of metabolic syndrome and chronic kidney disease with nonmuscle invasive bladder cancer recurrence and progression

Christabel Egemba et al. Urol Oncol. 2025 Aug.

Abstract

Introduction: Metabolic syndrome (MetS) has been associated with the pathogenesis of multiple solid tumors and chronic kidney disease (CKD) is related to higher incidence of urinary tract malignancy. Both MetS and CKD are prevalent in the same population of bladder cancer patients and are potentially modifiable risk factors. However, it is unclear whether they impact nonmuscle invasive bladder cancer (NMIBC) outcomes. We aimed to assess the effect of MetS and CKD on the risk of recurrence and progression of NMIBC.

Methods: A retrospective cohort study of 500 patients with NMIBC was conducted at a single institution from 2010-2022. CKD was defined as a past medical history of CKD at the time of presentation and MetS was defined as having at least 3 of the following: BMI ≥30 kg/m2, hypertension, diabetes and elevated triglycerides. The cohort was categorized into 4 groups: MetS alone, CKD alone, both CKD and MetS, and neither. Univariate Kaplan Meier and cox regression analysis were conducted to determine whether MetS or CKD along with known clinical predictors influenced recurrence and/or progression.

Results: There was no statistical difference in NMIBC time to recurrence or progression for patients with CKD alone, MetS alone, CKD+MetS and neither condition. However, hypertension was significantly associated with a shorter time to progression (P = 0.03). As expected, receipt of BCG was associated with a decreased risk of recurrence and progression over time (HR 0.50, P < 0.0001; HR 0.28, P = 0.0002 respectively). Older age was associated with an increase in progression risk (HR: 1.04, P = 0.024).

Conclusion: While both MetS and CKD are prevalent in the same population affected by bladder cancer patients, these conditions do not impact recurrence and progression in NMIBC. Nonetheless, NMIBC patients with MetS and CKD should strive to maintain good control of their chronic conditions to avoid disruption of treatment due to end-organ damage and associated sequelae.

Keywords: Bladder cancer; Chronic kidney disease; Metabolic syndrome; Recurrence.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References